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E45 ICD-10-CM Code: Retarded development following protein-calorie malnutrition

Billing Status: YES. This is a valid, specific, and billable ICD-10-CM reference.

Coding at a Glance

Tabular directives
3 inclusion terms · 2 Excludes1 · 2 Excludes2
Risk adjustment
CMS-HCC V22 category 21

Inpatient Payment Groups (MS-DRG)

Potential MS-DRG participation — not a DRG assignment.

MS-DRGs this diagnosis helps define, as principal or secondary, per the CMS ICD-10-CM/PCS MS-DRG Definitions Manual v44, Appendix B.

  • MS-DRG 640 — MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC (MDC 10)
  • MS-DRG 641 — MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC (MDC 10)

A diagnosis appearing in a group's logic does not by itself determine the DRG assigned to a stay; the grouper uses the full claim.

Coding instructions

Official Tabular Instructional Notes: the inclusion, exclusion and sequencing notes published for E45 in the official ICD-10-CM tabular list, quoted as published.

Source: CMS/CDC — ICD-10-CM Tabular ListRelease: FY2027Effective: October 1, 2026

Trace:FY2027 changesChange historyRelease, file and checksum

Notes without a marker are published on E45 itself; “inherited from” names the category or block whose note applies here.

Inclusion Terms

Alternative terms the tabular list files under this code.

  • Nutritional short stature
  • Nutritional stunting
  • Physical retardation due to malnutrition

Excludes1 — Not Coded Here

Conditions generally not reported together with this code (Excludes1) -- an error unless the two conditions are documented as unrelated to each other (ICD-10-CM Official Guidelines, Section I.A.12.a).

Source: inherited from E40-E46

Excludes2 — Not Included Here

Conditions not covered by this code, but which may be reported alongside it when both are present.

Source: inherited from E40-E46

Coder workflow for E45

MedCoder structured workflow — derived from this code’s own official record

Before you code E45

  1. Check the Excludes1 note: if the documentation supports a condition named there, do not simply proceed with E45. Excludes1 conditions are not reported together with this code unless the record shows they are unrelated (Guidelines I.A.12.a).

    See the official tabular notes

Choose the right path

  1. Does the documentation support a condition named in E45’s Excludes1 note?
    Yes → Do not simply proceed: review the excluded code. Both are reported only when the record shows the two conditions are unrelated.
    No → Continue.

    ReviewK90, E64.0

Consider E45. Then confirm the code is valid for the date of service in the Verify section.

Documentation check

The provider’s diagnostic statement
Codes are assigned from the provider’s documented diagnosis, not from clinical criteria, test values or a medication list (Guidelines I.A.19).

Official instructions as workflow

  • Excludes1 — check before selecting E45(2 notes)

    Coding workflow: If the documentation supports a condition named in this note, do not simply proceed with E45: the two are not reported together. The one exception is when the record shows the two conditions are unrelated to each other.

    CompareK90, E64.0

    See the official tabular notes · Guidelines I.A.12.a

  • Excludes2 — not part of E45(2 notes)

    Coding workflow: The conditions named in this note are not included in E45. When the record documents both, both may be reported; the note is a boundary, not a prohibition.

    CompareT73.0

    See the official tabular notes · Guidelines I.A.12.b

Coding decision scenarios

Pattern scenarios for this code’s structure — decision rules, not clinical cases

Documentation: Both the condition E45 describes and a condition named in its Excludes1 note are documented for the same encounter.

Coding question: Can both codes be reported?

Path: Review the Excludes1 note and the excluded code, and look for a provider statement on whether the two conditions are related.

Reason: Excludes1 means the two are not coded together; the exception is when the record shows the conditions are unrelated to each other (Guidelines I.A.12.a).

ReviewK90, E64.0

Every row is derived from this code’s own record — its title, tabular notes, 7th-character family and same-category siblings — with fixed MedCoder wording; nothing is inferred about a patient. The official notes and guideline text are in the sections each row links to, and they control.

Don’t confuse E45 with…

MedCoder analysis — pairs from this code’s official notes, distinctions written by MedCoder

The codes most likely to be picked instead of E45 — named in its own official notes, or sharing its laterality or encounter family — with what separates them and which documentation moves the case. Each links to the full comparison.

  • K90— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of intestinal malabsorption moves the case to K90; the two are not reported together unless documented as unrelated.

    Full comparison: E45 vs K90 →

  • E64.0— Excludes1 conflict (Excludes1 — generally not reported together)

    Not coded here — the tabular list excludes this pair for the same encounter.

    Not reported together with this code, except where the two conditions are documented as unrelated.

    What moves you there: Documentation of sequelae of protein-calorie malnutrition moves the case to E64.0; the two are not reported together unless documented as unrelated.

    Full comparison: E45 vs E64.0 →

  • D50— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of nutritional anemias adds D50; it is not part of this code and both may be reported when both are documented.

    Full comparison: E45 vs D50 →

  • D53— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of nutritional anemias adds D53; it is not part of this code and both may be reported when both are documented.

    Full comparison: E45 vs D53 →

  • T73.0— Excludes2 relationship (Informational)

    Distinct conditions — both may be reported.

    A distinct condition — both may be reported when both are documented.

    What moves you there: Documentation of starvation adds T73.0; it is not part of this code and both may be reported when both are documented.

    Full comparison: E45 vs T73.0 →

Relationships are read from this code's own official notes, its laterality siblings and its encounter family; the wording of each distinction is MedCoder editorial, and the documentation named in each “what moves you there” line is the official note phrase or sibling title itself. Source: CMS ICD-10-CM tabular instructional notes; ICD-10-CM Official Guidelines, Section I.A.12.a.

Code Overview

Retarded development following protein-calorie malnutrition is a billable ICD-10-CM diagnosis code (E45).

MedCoder summary Summary composed by MedCoder from this code's official ICD-10-CM record. The tabular instructional notes themselves appear verbatim below.

Indexed Clinical Terms (8)

Official source data — entries quoted as published, in the Index’s own lookup phrasing

Clinical term phrases from the official ICD-10-CM Index to Diseases and Injuries that map to this code. These are alphabetic-index entries shown as the Index writes them — lookup phrasing, not necessarily the wording of a final diagnosis.

Verify Before Coding

  • CC as a secondary diagnosis (FY2027). Can raise the stay's MS-DRG severity tier.

From the code registry, the Medicare Code Editor, and the MS-DRG Definitions Manual. Check it against a full claim in Claim Check.

Relationships & Classification

MedCoder structured relationships — computed from published CMS and AHRQ datasets

Other codes that name E45 or its code family, from the CMS ICD-10-CM tabular instructional notes. Tabular-note edges are stored at the code family level that carries each note.

Referenced by 4 Excludes1 notes across 3 chapters: E34.3 — Short stature due to endocrine disorder, R62.5 — Other and unspecified lack of expected normal physiological development in childhood, R63.6 — Underweight, Z72.4 — Inappropriate diet and eating habits.

These codes’ tabular lists mark this diagnosis as mutually exclusive — not reported together unless the conditions are documented as unrelated.

Referenced by 3 Excludes2 notes across 3 chapters: E64.0 — Sequelae of protein-calorie malnutrition, R60.1 — Generalized edema, Z59.4 — Lack of adequate food.

These codes’ tabular lists name this diagnosis as distinct — both may be reported when both are documented.

Referenced by 3 Code First instructions across 3 chapters: E08 — Diabetes mellitus due to underlying condition, G63 — Polyneuropathy in diseases classified elsewhere, H28 — Cataract in diseases classified elsewhere.

Each of these codes carries a Code First note naming this condition — when that code is reported, THIS code is sequenced first, ahead of it.

Referenced by 2 Code Also instructions: R63.31 — Pediatric feeding disorder, acute, R63.32 — Pediatric feeding disorder, chronic.

These codes suggest coding this condition alongside when both are present.

MS-DRG Grouper Relationships (FY2027)

Potential MS-DRG participation — not a DRG assignment.

FY2027 MS-DRG: CC — Complication or Comorbidity. Reported as a secondary diagnosis, this code raises the stay's MS-DRG severity tier — except when the principal diagnosis is one of 9 clinically related codes on its CMS exclusion list.

Named in the grouper logic of 2 MS-DRGs: DRG 640 (MDC 10), DRG 641 (MDC 10).

From the CMS MS-DRG Definitions Manual (Appendices B and C). Actual DRG assignment depends on the complete claim.

Clinical classification (AHRQ CCSR):END008 — Malnutrition (default).

Clinical Classifications Software Refined (CCSR) for ICD-10-CM Diagnoses. Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality.

Related Codes

Same clinical process (MS-DRG)

Acts as CC — raises the severity of other admissions. CMS groups these diagnoses into one MS-DRG principal-diagnosis exclusion process — a CC/MCC on this list never raises severity when the principal diagnosis is also on it.

E40 — Kwashiorkor, E41 — Nutritional marasmus, E42 — Marasmic kwashiorkor, E43 — Unspecified severe protein-calorie malnutrition, E44.0 — Moderate protein-calorie malnutrition, E44.1 — Mild protein-calorie malnutrition, E46 — Unspecified protein-calorie malnutrition, E64.0 — Sequelae of protein-calorie malnutrition

Same clinical category (CCSR)

AHRQ's Clinical Classifications Software groups these diagnoses under the same clinical category (Malnutrition).

E40 — Kwashiorkor, E41 — Nutritional marasmus, E42 — Marasmic kwashiorkor, E43 — Unspecified severe protein-calorie malnutrition, E44.0 — Moderate protein-calorie malnutrition, E44.1 — Mild protein-calorie malnutrition, E46 — Unspecified protein-calorie malnutrition, O25.10 — Malnutrition in pregnancy, unspecified trimester, O25.11 — Malnutrition in pregnancy, first trimester, O25.12 — Malnutrition in pregnancy, second trimester, O25.13 — Malnutrition in pregnancy, third trimester, O25.2 — Malnutrition in childbirth, O25.3 — Malnutrition in the puerperium

Same Index main term, other category

The ICD-10-CM Index to Diseases and Injuries files this code under the main terms “Dystrophy, dystrophia”, “Dwarfism”, “Development”, …; these codes share that main term but sit in a different category of the Tabular List.

E23.0 — Hypopituitarism (pituitary), E23.6 — Other disorders of pituitary gland (adiposogenital), E30.1 — Precocious puberty (sexual, precocious NEC), E31.8 — Other polyglandular dysfunction (polyglandular), E34.31 — Constitutional short stature (constitutional), E34.321 — Primary insulin-like growth factor-1 (IGF-1) deficiency (Laron-type), E34.328 — Other genetic causes of short stature, E72.03 — Lowe's syndrome (oculocerebrorenal), E72.09 — Other disorders of amino-acid transport (nephrotic-glycosuric), E75.6 — Lipid storage disorder, unspecified (retinal, in, systemic lipidoses), F79 — Unspecified intellectual disabilities (tardy, mental), F80.1 — Expressive language disorder (delayed, language), F80.9 — Developmental disorder of speech and language, unspecified (delayed, speech), F81.0 — Specific reading disorder (reading), F81.2 — Mathematics disorder (delayed, arithmetical skills), F81.81 — Disorder of written expression (spelling), F81.89 — Other developmental disorders of scholastic skills (delayed, specified learning skill NEC), F81.9 — Developmental disorder of scholastic skills, unspecified (delayed, learning skill), F82 — Specific developmental disorder of motor function (motor function, specific), F88 — Other disorders of psychological development (delayed, mixed skills), +58 more

Lab tests where this diagnosis supports Medicare coverage (NCD)

Medicare's National Coverage Determination (NCD) program lists this diagnosis as medical justification for these lab tests.

Blood Glucose Test, Iron Panel, Prothrombin Time Test and INR (PT/INR), Thyroid Stimulating Hormone (TSH)

Contextual Map

Every relationship of E45 in one view: hierarchy, official tabular instructions in both directions, clinical classification, risk adjustment, MS-DRG participation, index terms and change history — each edge carrying the CMS source it derives from.

Run E45 with these 18 related codes in Claim Check

Hierarchy

Excludes1

Excludes2

Referenced by Excludes1 notes

Referenced by Excludes2 notes

Referenced by Code First instructions

Referenced by Code Also instructions

Clinical classification (CCSR)

MS-DRG Grouper

MDC crossing

  • MDC 10 — Endocrine, Nutritional and Metabolic Diseases and Disorders[MDC crossing]: “Endocrine, Nutritional and Metabolic Diseases and Disorders — the grouper's crossing between diagnoses and procedures: a principal diagnosis sets the MDC, and same-MDC procedures move the stay to its surgical DRGs. 5,013 same-MDC procedures group here; browse them on the MDC page.”— CMS MS-DRG Definitions Manual · FY2027

Index entries

  • Development, arrested, due to malnutrition[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Dwarfism, nutritional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Dystrophy, dystrophia, due to malnutrition[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Dystrophy, dystrophia, nutritional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Nutritional stunting[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Retardation, growth, due to malnutrition[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Retardation, physical (child), due to malnutrition[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027
  • Stunting, nutritional[Index term]— CMS ICD-10-CM Index to Diseases and Injuries · icd10cm-fy2027

Change history

  • FY2016 — In the code set at ICD-10-CM adoption [Change history]— CMS release files (code change ledger) · icd10cm-fy2016

Sources for this page

Codes, titles, notes, index terms and mappings on this page are transcribed from the datasets below. Relationships MedCoder computed and text MedCoder wrote are labelled where they appear.

Code, title, tabular notes and index terms Official source data
CMS/CDC ICD-10-CM FY2027 tabular list, index and tables, effective October 1, 2026 Release, file and checksum · Publisher’s page
Claim edits Official source data
CMS Definitions of Medicare Code Edits — v44.0 (October 2026) Release, file and checksum · Publisher’s page
Inpatient payment groups Official source data
CMS MS-DRG Definitions Manual (incl. Appendix B diagnosis index, Appendix C CC/MCC list, Appendix E procedure index) and IPPS Final Rule tables — v44 Release, file and checksum · Publisher’s page
Change history and date-of-service validity Official source data
CMS ICD-10-CM release addenda, ingested release by release into the change ledger Release, file and checksum · Publisher’s page
Comparisons, relationships and the contextual map MedCoder structured relationship
Computed by MedCoder from the tabular notes and tables above; every derived relationship is marked as derived where it appears
Summary and FAQ answers MedCoder explanation
Written by MedCoder to explain the sources above: drafted with AI assistance, checked by a person against the release files, and labelled as MedCoder text where it appears. Not official text.

Labels on this page: Official source data · MedCoder structured relationship · MedCoder explanation. How to read the labels · All data sources and release dates

Cite this page

Reference this page in a research guide, syllabus or article. The release is included because code content changes each year.

MedCoder.ai. "E45 — Retarded development following protein-calorie malnutrition." ICD-10-CM FY2027. https://medcoder.ai/icd10/code/e45-retarded-development-following-protein-calorie-malnutrition

Change history

  • FY2016 — October 1, 2015
    In the code set at ICD-10-CM adoption
    Retarded development following protein-calorie malnutrition

No changes since FY2016 — additions, deletions, description changes and billable-status changes are tracked through FY2027, and none are recorded for this code. Note changes are tracked from FY2027 only.